cavus foot
AUTHOR: Marc Mitnick DPM
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WHAT IS A CAVUS FOOT
Also known as a high arched foot, as the name implies, is pretty much the exact opposite of a flat foot and because of this has its own inherent set of potential problems.
CAUSES OF CAVUS FOOT
Most people who have high arched feet find this as just part of their normal skeletal structure.
neurological cavus foot
There are many people who have a cavus structure as a result of neurological diseases such as:
- cerebral palsy
- Charcot-Marie-Tooth disease
- spina bifida
- polio
- muscular dystrophy
- Friedreich's ataxia
In the case of the neurological origins of cavus foot, this is usually a result of weakening of the muscles that flatten the foot resulting in a relative strengthening of the muscles of the foot and leg that raise the arch.
In the case of neurological origins, the high arched foot tends to be a progressive problem usually resulting in some form of bracing to protect against drop foot and to aid in better gait management. Surgical intervention is also likely in many cases in an effort to reduce the effects of the high arch and add more stability to the foot overall.
Most cases of cavus foot deformity seen in the office is of the idiopathic or natural occurring form which in the majority of cases is much less severe then the neurological type. Nonetheless the high arched foot is subject to a multitude of potential problems.
IMPLICATIONS OF A CAVUS FOOT STRUCTURE
The naturally occurring high arch can be further divided into two sub-classes: rigid and flexible.
RIGID CAVUS FOOT-deformity, the arch stays virtually the same height whether the patient is on or off his foot.
Compared to a more flexible foot, the rigid high arched foot tends to be a very poor shock absorber. One of the functions of the foot during the gait cycle, in addition to getting us from point A to point B is to absorb the shock of the heel hitting the ground and preventing this impact from traveling up the leg to the lower back. Because the rigid high arched foot has very little, to almost no subtalar joint motion (the joint just below the ankle joint), the impact of the heel hitting the ground is not absorbed and can lead to problems such as:
- ankle pain
- knee pain
- hip pain
- ilio-tibial band syndrome
FLEXIBLE CAVUS FOOT-deformity, the arch will be very high when a person is off weight bearing , but when they step down, their arch will flatten out to some extent.
More local to the foot, the cavus foot (both types) deformity can exacerbate certain problems.
- lateral column pain is more evident in the high arched foot, again, due to the mechanism in which the heel hits the ground, forcing the body to put more pressure on the outside of the foot during the midstance portion of the gait cycle.
- Lateral ankle sprains are also more common in the high arched foot simply because the heel bone (calcaneus) is slightly more tilted inward to the mid line of the body than a "normal" foot structure. This inversion of the heel increases the odds of twisting the ankle.
- capsulitis
- metatarsalgia
- sesamoiditis
- severe calluses on the ball of the foot, particularly under the first metatarsal bone
- hammertoe deformity (blue arrow). Hammertoes develop as a result of the toes riding up on the metatarsal heads due to the high angle that is formed at the height of the arch.
plantar fasciitis is also very common in the cavus foot structure.
In the rigid type of cavus foot the plantar fascial ligament may actually contract over time thus causing tremendous strain on the ligament.
In the more flexible cavus deformity, as the arch swings between high and low points the plantar fascia is being over worked as the foot goes through a large amount of motion within itself as one walks.
TREATMENT OF THE CAVUS FOOT
Treatment for either the rigid or flexible cavus deformity generally requires the use of an orthotic.
Custom orthotics-The problem here is that most store bought arch supports are not high enough to even come close to supporting the arch. The purpose of an orthotic in these cases is to more evenly distribute body weight across the whole foot and reduce the pressure on the heel and the ball of the foot. By evenly distributing body weight, the foot is able to function more normally and most of the problems mentioned in this article can be reduced or even eliminated. In many instances a custom orthotic will be necessary to properly support the arch.
Shoe selection-also becomes an issue in the very high arched foot. Most people with very high arches cannot wear shoes like loafers or non zippered boots as they simply cannot get their feet into those types of shoes. A good conservative laced shoe is a better choice.
Scraping of calluses that form on the ball of the foot and even on the heels in some individuals.
Surgery-In very severe cases, especially of neurological origin, surgical intervention may be necessary in an effort to lower the arch. The risks of the surgery should be weighed against the potential benefits.
- soft tissue release-such as an Achilles tendon lengthening and plantar fascial release
- osteotomy-surgical cutting of bone to either reduce the height of the heel (calcaneal osteotomy), or to lower the metatarsals (midfoot or metatarsal osteotomy)
- bone stabilizing procedure-triple arthrodesis where the rear foot joints are fused to lock the foot in a certain position.
see related article....ilio-tibial band syndrome
see related article....gait cycle
REFERENCES
Children's Hospital of Philadelphia
American College of Foot and Ankle Surgeons
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